Abstract

Background:Preoperative risk assessment is part of routine clinical management that evaluates a patient’s physical status and therefore surgical eligibility. These evaluations include age, comorbidities, physical status, and cardiac function, including resting LVEF. Patients with bladder cancer are especially high-risk due to older age and higher frequency of coexisting disease. This study aims to investigate the relationship between cardiac function reflected by resting LVEF and postoperative LOS in patients undergoing cystectomy or cystourethroscopy for treatment of bladder cancer.

Methods: Data were compiled from a database of patients undergoing treatment for bladder cancer at DUH from July 2000-August 2012. Decision to order a preoperative echocardiogram was based on clinical judgment. Echo reports were retrieved from the medical records and LVEF was recorded. Patients were stratified based on the values of LVEF. Echocardiogram with LVEF >50% were recorded as normal, and LVEF<50% were considered abnormal.

Results: Eighty-one patients were identified with an echocardiogram within 30 days prior to cystectomy or cystourethroscopy. Thirty-four cystectomy patients and 47 cystourethroscopy patients were identified. The chances of an abnormal finding from preoperative resting echocardiograms based on clinical judgment range between 10%- 22%. Thirty-one cystectomy patients with normal echocardiogram had a mean LOS of 14.3 days. Three cystectomy patients with abnormal echocardiogram had a mean LOS of 22.6 days. In the cystourethroscopy cohort, 37 patients had normal echocardiogram and averaged 2.5 LOS, while ten patients with abnormal echocardiogram averaged 2.6 LOS.

Conclusion: The findings from preoperative echocardiogram is not a predictor in the LOS following cystourethroscopy although there was a trend towards longer LOS in patients undergoing cystectomy (p=0.09). Exploring other options such as exercise or stress echocardiogram as well as fitness assessments such as cardiopulmonary exercise testing may provide more powerful surgical risk stratification and prognostic information to urologists managing patients with bladder cancer.